I recently watched a family member go through this. A few things that were sobering to see:
- Three weeks in she was buried in paperwork. One chemo treatment would turn into 4-5 invoices from different subcontractors at a single hospital, some covered by her insurance, others not covered. Her insurer denied claims arbitrarily and made her go through a bunch of invasive and unnecessary procedures to prove her illness.
- Her insurer started calling her incessantly, insisting that she join some sort of program where they would “help” her make decisions about her care. It undermined the confidence she had in her doctors and the decisions she was trying to make, which is a terrible feeling for anyone to go through when they are sick with cancer and trying to survive.
- There were a series of insurance “land mines” on the horizon - forget to renew this thing on this random date 2 months from now? You’ve lost your insurance.
The whole healthcare and insurance system is a dark pattern, even for working adults who are fully covered.
Once insurance is involved and has to pay, the system is geared towards shifting as much of this as possible to the patient in the current US system. So now you have the provider and the insurance company working to get the patient to pay. Nobody is on the patient's side; the insurance company is best served by having the patient die as quickly as possible, the provider is best served making the patient pay as much as possible. It's become a dystopian nightmare over the last 25 years.
I recently suffered a knee injury that cost into the six figures and required experts to help me with insurance billing. I think we need to remove restrictions regulating how new doctors are trained, and how many new doctors and other medical professionals get lice sed each year. I would even get rid of the requirements to have a license.
I don't think it should require $320k in student debt to become a doctor. I think that traps people who may switch careers later into a career they dislike. The only reason the prices are that high is that a limited number of schools control a monopoly on healthcare education.
I saw that insurance companies are legally capped to only keep 20% of each dollar spent on healthcare. A competitive insurance company could keep less of course. I also saw that out of each dollar spent on healthcare, 23% goes to prescription drugs, 22% to doctors, 20% to office and clinic visits, 16% to hospitals. https://www.ahip.org/health-care-dollar/
Prescription drugs should not be as expensive as they are either. This is due to overly strong patent laws preventing competition and stifling innovation. Each new drug is the end result of an avalanche of human work through centuries and the one little idea that advances things slightly should not be long term locked up by a patent. This greatly slows the creative avalanche. I think we would see far more new drugs at a far lower cost if we did away with patents. Science should not be owned by any individual or group.
The cost of healthcare is ballooning and is out of reach of many people and bankrupts many more. The number one cause of bankruptcy in America is medical bills. Healthcare costs as a share of GDP have grown from 5% in 1960 to 18% in 2018. This shows that the cost itself is the problem, not just insurance companies. https://www.statista.com/statistics/184968/us-health-expendi...
How can we solve healthcare's cost while improving outcomes and getting face time with medical professionals for patients? I am proposing we allow many more people to enter the field by removing artificial regulations preventing competition. This is a standard approach suggested by economists... https://www.investopedia.com/university/economics/economics3...
As an entrepreneur, I would like to see doctors innovate with new business models in healthcare... Unfortunately business models are strictly regulated in this industry just as supply of medical professionals is regulated.
What are your thoughts on how to solve the problem of the very high cost of healthcare?
I'm curious to find out what it would take for someone to create a service that counters some of these dark patterns.
The abundance of companies using dark patterns in their subscriptions to prevent subscription cancellations has led to other companies offering services that allow you to manage your various subscriptions with ease and cancel subscriptions with even greater ease. I'm wondering what it would take to apply the same mindset to managing healthcare-related paperwork.
Making insurance carriers legally required to act as a fiduciary to the person holding insurance benefits would be a good start.
States requiring medical services to bundle billing through a state agency (one place to pay) would be another. Although this would in practice mean a bigger government, I think a majority of people would agree to it. Likewise apportionment of payments would go to approved and priority based on service date.
Of course the next step would be to limit exposure to credit to a "single" entry for all medical related bills, and limit the total payroll deductions allowed for medical bills to a total of 10% of one's gross income (deduction pre-tax).
This would take a lot of work inside individual states and at the federal level.
Insurance companies are often used as the punching bag for healthcare costs. In reality, insurance companies are just a payment method for the true cost - enormously expensive doctors. Insurance companies are portrayed as having crazy profits, but in reality the insurance company Cigna has a profit margin of 6%.
The American Medical Association realized a century ago that medical care demand is inelastic... Basically if you need medical care, you will pay any price to get it. Doctors took advantage of the situation by passing laws and regulations limiting the number of new doctors allowed each year, who can practice medicine, and the types of businesses that can compete. This greatly limited the supply of doctors. There are not enough doctors to fully meet demand. The basic laws of economics say that when you have strong and inelastic demand, and a limited supply then prices will go through the roof.
I propose we remove these artificial limits that are grossly enriching doctors. If you allow anyone to practice medicine, just like we allow anyone to prepare and serve food or distribute goods then you will end up with a lot more competition. This will result in far better patient outcomes at a far lower price.
The AMA will argue that without limits on who can practice medicine huge numbers of people will die. This is false. Our lives rely on many businesses that if they screw up would kill us. Everything from farming to distribution to food prep to construction needs to perform and deliver for us to survive. The AMA is self serving and greedy. There is no reason an individual surgeon should make hundreds of thousands of dollars. There is no reason certain business types should be legally prevented from competing. Imagine if you had the efficiencies of a business like Amazon or Google in healthcare.
Imagine if you could see statistics on the performance of every doctor and hospital in the country, then decide where you wanted to get treated.
Allow competition in healthcare by removing limits on the number of doctors each year and by allowing new business types that can take advantage of scale and specialization. This will drive down healthcare costs a hundredfold and allow everyone in America access to top healthcare at reasonable prices
I'm sorry your family member went through this. That's terrible and no one should have to deal with that kind of treatment.
I'll echo much of what you said. When I was 21, I was diagnosed and treated for malignant melanoma (skin cancer) that had metastasized to my lymph nodes. The treatment worked and I've been healthy for many years. That said, it changed the way and manner in which I deal with billing and insurance, so I'll share a couple of things that I learned in case someone else runs into the same issue.
- Do not immediately pay any invoice. Wait until the explanation of benefits arrives first and then verify that the two match. Basically, verify that the doctor is billing what the insurance company states is uncovered. Sometimes they're different and that indicates a problem.
- Check all statement of benefits for uncovered claims. It's important to understand why a claim is denied. If a doctor is not in network, it's important to drop them right away. If the doctor used an unapproved billing code or sequence of codes, it's important to know this and insure that this doesn't happen again or else it gets expensive. Alternatively, the doctor's office can resubmit the claim using different billing codes.
- Just because a doctor shows up under the "find a doc" in the insurance search doesn't mean they're in network. PHCS is notorious for this, which happens to be the network used by the health sharing ministries (which is part of the reason why these organizations are a terrible idea.) Anyway, even if a doctor is listed, it doesn't mean that they're using that tax id for their services. The insurance company and the underwriter maintain a database of tax ids that really determine who is in network or not. The doctor nor the front desk will have this information. The billing department does. As such, the process is to call billing, before the appointment, and get their tax id. Then, call your insurance and verify the tax id directly. Some phone support want to just verify the name. That is not good enough. Verify the actual tax id and insist that this is what is checked.
- Even if the tax id is verified, the claim may still be denied. This an innumerable number of reasons why this may happen. I had one denied because they billed a new patient the same day as a procedure. Anyway, the only way to truly know the cost is to get the procedure code and the tax id and then verify with the underwriter that this is covered. I mention the underwriter because the insurance company doesn't have this information, at least the ones I've used. Generally, the insurance company will refuse to give the underwriters contact and the underwriter will refuse to talk to you even if you get it, so the insurance company has to call them and then verify both the tax-id and billing codes. This only works some of the time, but they really can do it if they want. Most of the time, I don't go this far unless there's a dispute. Generally, verifying the tax-id is good enough.
- Hospitals do not just hire their own people. Most are filled and staffed with medical groups who use their own billing. Here's where things gets stressful. You basically have to be forceful, while sick, and ask each new physician and lab tech what medical group they work for and what their tax-ids are. The really crappy situations occur when the hospital gets slammed and then they bring in someone to help cover the gap and they use a tax-id that's not in network. This gets astronomically expensive quickly. And, look, the hospital will get tired of you asking. I get it. If I'm there, I'm either sick or dying and don't want to ask either, but these surprise bills can bankrupt you.
- Hospitals may randomly apply funds paid to random invoices. If this shell game goes on long enough, bills can be sent to collections even if you've paid them purely because funds paid were applied to new invoices and not old. Generally, hospitals will try 3 or 4 times to collect on an invoice. If you know one has been paid, verify the money has been collected from checking or credit, and then call the hospital to complain. It needs to be fixed sooner rather than later.
- As far as paperwork, I save the doctors notes from that day, the insurance explanation of benefits, the bill, and the receipt of payment from my bank, in a single file labeled for that day of service. This has saved my ass multiple times because I can quickly determine whether a bill has been paid and when.
- Do not overpay. Ever. Getting money back from a hospital is extremely difficult. Then, they'll randomly apply the credit to new invoices, which screws up the bookkeeping. This is part of why I delay paying invoices till I know they're good.
Alright, that was longer than I anticipated. Anyway, the situation is ridiculous and I hope no one here has to go through this mess. Hopefully, what I wrote above will help someone else.
...also, you've called out a very significant pain point for lots of people in the American health system, i.e. managing and paying bills while dealing with the Kafka-esq processes. Your process is steps towards a solution.
Can your process of ensuring bills are paid correctly be turned into a business? Can it sold as a service - not to hospitals, not to employers, not to insurance companies - but to us? We buy the service and know we can trust it has our interests at heart, esp. when we are at our most vulnerable.
I've had to jump through hoops with insurance bills before, it isn't pleasant and I've got good health insurance.
Pricing structure would be challenging...monthly and use when needed, per transaction, etc?
(didn't do any deep searching before posting, so I'm betting a hospital billing concierge service already exists...)
Yea, this sounds like a great idea. If I got a major sickness, I know I'm financially screwed anyway, even with insurance, because I have no idea how to navigate the insurance/hospital/doctor bureaucracy. I'd rather hire someone like OP to be my "health care agent" and do all this paperwork and chasing people down, in hopes he might be able to make my out of pocket bill $100K rather than $1M. That kind of service would be worth more than lawyers charge.
Thanks, this was very informative and will change how I handle medical bills.
Unrelated comment: I recognized your handle from some of your earlier posts where you said you're an independent researcher. I'd be interested in learning more about how you got started, if you're willing of course. You can contact me by email at the address in my profile.
Depending on the plan there are state insurance regulators you can appeal to who basically have the final say but I agree, the random denials etc... it's like the do it on purpose. There is also an appeal window of like 60 days in most cases so the best thing someone can do to help is help your family member manage and file appeals/paperwork as necessary. You can also find former insurance company employees who act as patient advocates and know who and how to call to get things done. A lot of them work at hospitals but you can find them outside as well. Sometimes your insurance will have a patient advocate. They are actually on your side and will help.
To play devil's advocate, looking at 5-year survival rates by country, you'd be 15-20% more likely to survive in the US after you contract cancer than in the Netherlands. YMMV.
> more likely to survive in the US after you contract cancer than in the Netherlands.
Not after you contract cancer. After it's been detected.
This is a common misunderstanding of the statistics.
If the Netherlands implemented a huge national screening programme and screened every man over 55 for prostate cancer, and then did nothing at all with those men (zero treatment) their 5 year cancer survival rates would go up. This is because some cancers are slow growing. Lots of men will die with prostate cancer, but not of prostate cancer.
But when we've given someone a scan and found prostate cancer it's hard to say "well, you have cancer, but we're not going to do anything", so you then start treatment. This carries risk of side effects and accidental harm which lower quality of life but might not provide any benefit.
5 year survival rates are just one measure, and you might want to look at life expectancy or quality of life measures instead.
If all that testing and treatment isn't increasing length of life, and is making quality of life worse, and is bankrupting people it's probably a good idea to look at a different way of doing things.
Did you factor wealth into that? I would hazard a guess that the bottom 20%-40% in the U.S. would have a considerably lower survival rate than the average for the rest of the country.
> Did you factor wealth into that? I would hazard a guess that the bottom 20%-40% in the U.S. would have a considerably lower survival rate than the average for the rest of the country.
The population survival rates for cancer in the US are higher than any other OECD country. That already includes people who don't have insurance or otherwise can't afford treatment.
Yes, but let's say in the U.S. the numbers are 100% survival for the richest 50% and 0% survival for the other 50%. Clearly the average survival rate is 50%. Now let's say the Netherlands has a flat survival rate of 50%. If I don't consider wealth, it doesn't matter which country I get care in. If I'm at 49.999% of wealth in the U.S., the difference is 0% survival vs 50%.
We know healthcare quality and healthcare cost are correlated, e.g. http://www.pnhp.org/news/2016/july/wealthy-get-more-health-c... , I think we can intuit that ability to bear cost and wealth are correlated. Outliers aside, I don't think you're going to argue to me that a homeless man in Detroit has a chance of getting the same quality of care as Jeff Bezos.
Simpson's paradox -- how you split up those percentiles matter, the question is how much.
> Yes, but let's say in the U.S. the numbers are 100% survival for the richest 50% and 0% survival for the other 50%. Clearly the average survival rate is 50%. Now let's say the Netherlands has a flat survival rate of 50%. If I don't consider wealth, it doesn't matter which country I get care in. If I'm at 49.999% of wealth in the U.S., the difference is 0% survival vs 50%.
Instead of just making up numbers that could hypothetically mean something, take a look at what's already been linked in this thread and you'll see that's not the case.
Instead of saying "take a look at what's already been linked" either link something that refutes my point or make a clear argument that does so.
The statement was:
> To play devil's advocate, looking at 5-year survival rates by country, you'd be 15-20% more likely to survive in the US after you contract cancer than in the Netherlands. YMMV.
I asked "Did you factor wealth into that?" and then backed it up with a hypothetical that shows how it could matter. I see no comments regarding whether the numbers given factor wealth in or if anyone can clearly show it doesn't matter. You want to challenge my claim that quality of healthcare is correlated with ability to pay, fine, but "look it up" isn't an argument.
It is for the entire population. I personally know people on welfare that received advanced new treatments and survived "terminal" cancer to this day.
The overall cancer survival rate in the US for males is around 67%, which is extremely high even by developed world standards. It wouldn't be possible to have a survival rate that high if a large fraction of the population was excluded from treatment.
I responded to another commenter, Simpson's Paradox -- 67% average doesn't mean that I can expect 67%. Healthcare efficacy is correlated with wealth (i.e. cost of healthcare and ability to bear that cost). To get 67%, let's say the top 67% of Americans have a survival rate of 100% and the bottom 33% have 0% survival rate. The average is 67%, but I really hope I'm not in the bottom 33% and get cancer.
I don't know what you think a "large fraction of the population" equates to, but in this theoretical, 33% of the population being guaranteed to die isn't exactly ideal.
That survival rate came from a study in Lancet Oncology. It is not controversial that the US has exceptionally high cancer survival rates.
This is attributed to two factors: much more testing/screening than in most countries, which detects cancer at earlier and more treatable stages (though at high cost), and most new cancer-related treatments are developed and available in the US first so any resulting reductions in mortality show up in that population first.
As an example, my "anecdote" was cured of terminal cancer by an experimental drug therapy in late trials. Several years later it is FDA approved and becoming available in the rest of the world but at the time the only people receiving that treatment were in the US and it was correlated with a material increase in survival rates for that kind of cancer.
What study? Did it break down other factors for survival or are you arguing that the 350 million Americans all have exactly the same chance of surviving cancer?
I don't know why you're quoting "anecdote," you gave a textbook example of anecdotal evidence, which is not data. My uncle Bob survived testicular torsion, therefore all uncle Bobs will survive testicular torsion. How many people in the U.S. with that exact same cancer did not receive that particular experimental drug therapy? Did that one person, or even all the people included in the trial, change the survival rates in America during that time period?
If you test a lot of people, and also have a many false positives (i.e. people who are diagnosed with having cancer, but actually do not have it), and then "treat" them, you will end up having a high cure rate..
That’s terrible. I really feel for low-income cancer patients in the US. I’ve dealt with cancer in the family (in Canada) and found it difficult enough, and never had to deal with insurance paperwork.
A big factor here seems to be lifetime limits to benefits:
> Financial toxicity led Fumiko Chino to co-write a research letter in JAMA Oncology last November. After her husband surpassed his insurance policy's $500,000 lifetime limit, Chino drained her savings to pay for his treatment. When he died, she was left hundreds of thousands of dollars in debt.
However, these limits were outlawed by the Affordable Care Act, even for grandfathered plans:
And before people get too comfortable -- Every single "Obamacare replacement" plan does away with the ban on lifetime caps either directly or indirectly. These are enormously beneficial to insurance companies (they essentially have unlimited liability without them) and there is a ton of money to have the caps reinstated.
> These are enormously beneficial to insurance companies (they essentially have unlimited liability without them) and there is a ton of money to have the caps reinstated.
I don't understand why you'd phrase it this way. Under the ACA, 80% of premiums have to go to medical care. A dollar saved providing care disproportionately benefits the premium payers, not the company.
People act like all this money comes out of insurance companies' profits. Cigna's (to pick a random example), operating profit margin is 6.5%. There isn't this fat margin that insurance companies can use to offer additional benefits without raising rates. That's just the math.
Saying that this is about what "benefits the insurance companies" is gas lighting the public. Lifetime caps insure that you, the ratepayer, aren't on the hook for unlimited liability. Now, I personally am willing to pay higher rates so people don't die when they hit their lifetime limit. But don't piss on my leg and tell me its raining, acting like the money isn't coming out of my pocket.
The entire point of insurance is to pool risk so that a bunch of people together pay reasonable amounts, instead of a few people paying enormous amounts and the others paying less. Lifetime limits give you lower rates in exchange for making the insurance much less like actual insurance.
If we’re talking about “don’t piss on my leg and tell me its raining,” don’t sell me “health insurance” that will leave me high and dry if I ever really need it.
It's absurd to say that imposing a limit is somehow misleading for something sold as "insurance." "Actual insurance" almost always has a policy limit. Everything from car insurance to corporate liability insurance has a limit. I can't think of any "actual insurance" besides health insurance that doesn't have a limit.
Again, I'm not arguing against having health insurance be unlimited. I'm taking exception to your rhetorical mode, which I think is dishonest. By making the issue about the "big greedy insurance company," you obscure the fact that the public will be paying for these benefits. You're selling the public something as a "you can have your cake and eat it too" but that's a bill of goods.
FWIW, insurance in other countries has limits, but rather high ones.
For example, my private liability insurance (50 EUR/a premium) is limited to 50 million EUR/event. So, yeah, if I ever accidentally create 60 million EUR damage (in one fell swoop), I'll be broke.
My travel health insurance is 12.50 EUR/a, and pays 100% of medically necessary out-patient and hospital treatments (for an unlimited number of trips up to 8 weeks), as well as repatriation, without limit. (This works, presumably, because if shit hits the fan, they'll fly you home and hand you off to the normal health insurance).
I can't emphasise enough how good it is to be in a civilised society where the existential risks are covered and shared. Furthermore, because they are borne by someone (either insurers or gov't), there are also experts dedicated to managing them, and reducing them.
It all works because everyone is insured, so the insurers don't have to worry about adverse selection.
This raises a really important point. A limit that’s basically impossible to hit is very different from a limit that you’re basically guaranteed to hit if you have a major problem.
It's also how single-payer healthcare works in the majority of countries that have it.
The problem is simple - in most developed countries, health insurance doesn't bankrupt the people it serves. It also doesn't have policy limits for common terminal illnesses.
So why does this happen in the US - a country with insanely high costs and relatively mediocre health outcomes?
The problem isn't insurance, it's the influence that unregulated privatised insurance has had on health industry costs as a whole.
Hospitals, medical professionals, pharma companies, and insurance companies are all primarily motivated by profit, and will price gouge patients to the maximum extent possible.
Insurance companies may be regulated intermediaries, but in reality many insurance companies are actually owned by hospital chains.
They simply provide a layer of regulated bureaucracy that disguises and legitimises the price gouging.
So while technically it's true that insurance companies have regulated margins, it's also a misdirection. The true role of the insurers is to provide corporate and bureaucratic cover for the outrageous sharking and exploitative profiteering in the rest of the industry.
Customers - i.e. patients - most certainly do not benefit from this arrangement. Shareholders and CEOs very much do.
>in reality many insurance companies are actually owned by hospital chains.
Huh? In the US, Kaiser is the only integrated provider of insurance and healthcare that I know of. It actually is a fairly good model. Otherwise Cigna, Bluecross etc.. are strictly insurance companies that have contracts with other providers to provide care to their members.
> It's also how single-payer healthcare works in the majority of countries that have it.
Only a couple of countries actually have single-payer healthcare[0]. For those that do, treatment for complex, expensive conditions like cancer is regulated by the government much more strictly than in the US, with the result that patients have far fewer options for (covered) treatment. Incidentally, those countries, like the UK, tend to have dramatically worse cancer survival outcomes than the US does.
[0] The UK (if we ignore the divisions between the NHS in England, Wales, Scotland, and Northern Ireland) is one of the only ones.
Car insurance is sold in a 6-month or 12-month policy term, with a "lifetime limit" during that term. You can buy a new policy at the end of the term, but the insurance company isn't obliged to sell it to you.
Health insurance was typically sold in annual terms, with annual, lifetime (actual lifetime), and often per-event limits. Health insurers were not obliged to sell you the same policy at the same rate, the same policy at any rate, or any policy at any rate, either.
Hmm, you’re right. I always figured the non-minimum limits were per term. This Geico policy document I’m reading specifically states it’s per incident.
I don’t understand why this is only a problem in the US.
Are people so sick over there, are they continuously poisoning or shooting each other? Heck, even their life expectancy is not top notch.
If you actually want insurance, then that is exactly the right way to phrase it.
The purpose of insurance is to provide me a way to pay for disasters that I otherwise could not afford. To that end I make payments that, on average, leave me poorer. But since I can afford the payments and can't afford the disaster, it leaves my expected quality of life better off by reducing the variance in my expected outcomes.
When I am paying a premium to pay for normal things that I can actually afford, that is not serving as insurance. It is now just a bad deal for me, pay extra for a middleman that I have no reason to want.
I may not want that middleman, but health care insurance companies want to be one. They therefore want me to pay a premium to them for things that I could have afforded, and not cover things that I couldn't afford. To that end they work to construct deals with employers+government so that employees don't have a viable alternative to entering this deal no matter what my opinion is.
This would give them a large amount of business with a guaranteed profit margin. And leaves me uninsured exactly when I would have wanted to be insured. I understand exactly why they want to be in that line of business. But none of the rest of us should support that.
Incidentally, while we are at it, the ACA has a really bad perverse incentive. As you say, 80% of premiums have to go to medical care. Which means that if health care providers charge more, then "insurance" companies are allowed to profit more.
Now look at this from the point of the insurance company's CEOs. As long as they can predict the growth in medical expenses, growing medical expenses are good for their bottom line. Where then the incentive for cost savings?
Better yet, if they know that some of those medical expenses are fraudulent and can readily expose it, they can always keep their predictions of expenses in line with the reality by exposing just enough fraud to make their predictions accurate. This is an incentive to turn a temporary blind eye to fraud.
And so the ongoing explosion of medical expenses is good for insurance companies.
The scenario the parent poster is describing is where ACA is repealed and replaced, and presumably that replacement would also do away with the 80% medical loss ratio. In that scenario the insurance companies will likely just not reduce premiums from what they are today, netting them a huge windfall.
This is also why states like Alaska have seen ACA premiums fall over the past year or two. They instituted a state-wide reinsurance program, which means insurance companies' losses are capped at a reasonable amount per claim, then the state comes in and pays for the rest. This reinsurance program is funded in sort of a complicated manner, but basically it funnels the ACA tax credits that would have been paid to taxpayers, absent the reinsurance program, into the reinsurance program.
Rates go down when insurance company losses are capped, either by a lifetime or annual benefit limit or by legislation that says they'll be made whole, because losses are predictable.
> According to an April 2010 report prepared by the Democratic staff of the Senate Committee on Commerce, Science, and Transportation, the nation’s largest health insurers in 2009 had medical loss ratios ranging from 68 percent to 88 percent in the individual market; 78 percent to 84 percent in the small-group market; and 83 percent to 88 percent in the large-group market.
For major medical plans, sure. Short term plans (which are still unregulated and should not be allowed to use the term "health insurance") generally have MLRs in the neighborhood of 50%.
Also keep in mind, prior to ACA buying a major medical plan without through a large group required one to have no preexisting conditions. If you had one you were either denied or got an exception written into your policy that said they didn't have to cover anything related to that thing. That's one of the other major things that ACA did away with, and another reason premiums are higher.
United Healthcare's CEO received $17.4 million in compensation last year. I don't know anyone on the GS pay scale making that. That excessive compensation could've been directed towards healthcare delivery instead of padding someone's pockets.
Private insurance is beholden to shareholders, universal healthcare is beholden to citizen stakeholders. It's plainly obvious that the private insurance market in the US has failed us. Politics aside, from an economic efficiency perspective, it would be illogical for us to continue to operate the system as it currently exists.
EDIT: This isn't an emotional appeal, it's an economic appeal to cut the fat of unnecessary, expensive bureaucrats who have no accountability except to their shareholders, and no involvement in the delivery of care. Private insurance interests are in the collection of their piece of total revenue, not care delivered.
> Either way, the public is on the hook if the system is more generous.
The public ends up on the hook regardless, whether that's through higher premiums, government subsidies, or diminished quality of life and lower life expectancy. Socialized losses, privatized gains.
UHC paid out over $100 billion in care. How much it pays its CEO is completely irrelevant, except as an emotional appeal and rage bait. The system may not be functioning properly, but it has nothing to do with how much UHC's CEO makes, or shareholders make. (UHC's profit margin is just 7.5%).
The decision of whether to have limits on how much you're willing to spend for one case exists whether you have a private system or a public system. Either way, the public is on the hook if the system is more generous.
What strikes me as disingenuous about your posture is this: You are basically arguing that the insurers are introducing lifetime caps (making life much worse for the affected individuals, basically nullifying the whole point of insurance) not out of concern for their profit margin, but out of the goodness of their hearts to keep the premiums low for the paying public. That strikes me as unlikely.
Of course, if you don't impose these limits, the costs must be borne by the collective insured. However, if there is one government/single payer insurer, nobody would ever dream up the insane idea of saying, hey, if you're really fucked, we'll stop paying your health bills, so we can shave off a few dollars of everyone's premiums.
> not out of concern for their profit margin, but out of the goodness of their hearts to keep the premiums low for the paying public.
Lowering premiums allows insurers to win customers away from competing insurers. It's e.g. why HP sells business laptops with awful LCD panels. It's not because HP makes fat profits on each laptop (their margins are razor thin). It's because the lower price allows them to take sales away from competitors.
> However, if there is one government/single payer insurer, nobody would ever dream up the insane idea of saying, hey, if you're really fucked, we'll stop paying your health bills, so we can shave off a few dollars of everyone's premiums.
> In the UK, the NHS has a system based on QALYs — quality-of-life years. In crude terms, it values a year of normal health at £30,000, so if the proposed course of treatment will cost £150,000, the patient would need to have good prospects of having five years of normal life once the treatment is over to get it. For a patient who would need assistance to live because they can’t walk more than a few steps or what have you, the QALY figure might drop to £15,000, so the patient would have to have an expectancy of 10 years of assisted life to get the treatment.
Note that in the example in the story, the lifetime limit was $500,000, or 380,000 pounds. In the UK, the guy would've needed to live 12-13 years to justify spending that much. He had an aggressive cancer and died a year later, while receiving treatment. Under the U.K. system, the NHS would've been willing to pay well under $100,000 with that prognosis.
The idea that "one government/single payer insurer" systems wouldn't have these sorts of limits is the product of the exact gas-lighting I was complaining about. By focusing on the insurance companies, and the fictional fat profit margins out of which benefits can be paid for with no cost to rate payers, it totally obscures the fact that, at the end of the day, a functioning healthcare system needs to make decisions about when to cut off care.
> In the UK, the guy would've needed to live 12-13 years to justify spending that much. He had an aggressive cancer and died a year later, while receiving treatment. Under the U.K. system, the NHS would've been willing to pay well under $100,000 with that prognosis.
This is simply untrue.
There's too much wrong with your link to debunk it. It's almost entirely wrong. Mostly, there is a different QALY threshold applied when drugs are used for people with life expectancy of under 24 months, and also they're using an unsourced value for QALYs.
> Lowering premiums allows insurers to win customers away from competing insurers.
Absolutely. That's what leads to competition with insurance plans that are superficially more attractive ("hey, cheaper premiums"), while basically nullifying the benefits of insurance (by making you and your family broke when things turn bad - and then you die).
The alternate system doesn't need to optimise for "optics" & sales, but can optimise eg for QALYs.
Of course neither system can overcome the fundamental issue that you can't pay for unlimited treatment for all. But quite evidently, the US system leads to harrowing quandaries for many ill people and their families, worse overall health outcomes, higher overall costs, and richer health insurance CEOs than what's done in all other developed countries; and I still don't understand why you appear to defend it.
> But quite evidently, the US system leads to harrowing quandaries for many ill people and their families, worse overall health outcomes, higher overall costs, and richer health insurance CEOs than what's done in all other developed countries; and I still don't understand why you appear to defend it.
We're specifically talking about cancer treatment in this thread, where the data is pretty clear: the US has dramatically better survival rates for cancer in the US, and the gap is even wider for forms of cancer which are considered highly treatable.
Yes, people in the US pay a lot for cancer treatment, but the overall outcomes are not worse.
> No, the US massively over-tests and over-diagnoses cancer at very early stages, but this does not lead to better quality of life nor to longer life.
Prostate cancer is considered one of the most treatable forms of cancer. It's lethal if not treated. But given the proper intervention, a person can live for literally years (if not decades). The treatment isn't fun, but it's very effective, and most people consider it better than, you know, death. As of a few years ago, the survival rate for people with prostate cancer was over 90% in the US. People are actually more likely to die from an unrelated cause than they are to die from prostate cancer after treatment.
The UK, on the other hand, has an abysmal track record of treating prostate cancer - worse than every other OECD country, in fact. As of a few years ago, the survival rate was barely more than 50%. That is shameful , and it's ridiculous to dismiss that as "overdiagnosis".
Buit this is the point: The US appears to have better 5 year survival rates for prostate cancer because they massively over diagnos cancers thatwould otherwise not kill the patient. Once you've detected these cancers you don't need to provide any treatment at all, your 5 year survival rates increase. But when you do treat all these men you significantly decrease the quality of life for many of them without providing any benefit.
> Background: Overdiagnosis of clinically insignificant prostate cancer is considered a major potential drawback of prostate-specific antigen (PSA) screening. Quantitative estimates of the magnitude of this problem are, however, lacking. We estimated rates of prostate cancer overdiagnosis due to PSA testing that are consistent with the observed incidence of prostate cancer in the United States from 1988 through 1998. Overdiagnosis was defined as the detection of prostate cancer through PSA testing that otherwise would not have been diagnosed within the patient's lifetime.
> Methods: We developed a computer simulation model of PSA testing and subsequent prostate cancer diagnosis and death from prostate cancer among a hypothetical cohort of two million men who were 60–84 years old in 1988. Given values for the expected lead time—that is, the time by which the test advanced diagnosis—and the expected incidence of prostate cancer in the absence of PSA testing, the model projected the increase in population incidence of prostate cancer associated with PSA testing. By comparing the model-projected incidence with the observed incidence derived from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry data, we determined the lead times and corresponding overdiagnosis rates that were consistent with the observed data.
> Results: SEER data on prostate cancer incidence from 1988 through 1998 were consistent with overdiagnosis rates of approximately 29% for whites and 44% for blacks among men with prostate cancers detected by PSA screening.
> Conclusions: Among men with prostate cancer that would be detected only at autopsy, these rates correspond to overdiagnosis rates of, at most, 15% in whites and 37% in blacks. The observed trends in prostate cancer incidence are consistent with considerable overdiagnosis among PSA-detected cases. However, the results suggest that the majority of screen-detected cancers diagnosed between 1988 and 1998 would have presented clinically and that only a minority of cases found at autopsy would have been detected by PSA testing.
That's a lot of people being put through unpleasant surgery that has considerable side effects for no benefit.
> Buit this is the point: The US appears to have better 5 year survival rates for prostate cancer because they massively over diagnos cancers thatwould otherwise not kill the patient.
The methodology of that study is highly suspect, but even if we took it at face value - the magnitude of the effect that they propose is nowhere near enough to explain the difference in survival rates by overdiagnosis alone. It's a drop in the bucket.
> How much it [United Health Care] pays its CEO is completely irrelevant, except as an emotional appeal and rage bait.
That's a pretty significant exception, from the perspective of "designing" a social order.
It's a brute fact that humans measure their well-being in part by comparing their situations to those of their neighbors and of others with whom they come into contact. [0] People can become disgruntled, even envious, when they discover that they want things that others have but they don't. It's a fact of life: natural selection has hard-wired us to experience at least mild envy, which motivates us to try to improve our lot (by fair means or foul).
So how should we respond to that brute fact? I used to think that folks who resented high executive compensation should just get over it, or go and earn such compensation themselves. I remember listening approvingly to the old Eddie Chiles TV commercials: Don't have an oil well? Get one! [1]
These days, on the other hand, I'm increasingly realizing that this is unrealistic, and also that we broadcast an unrealistic message: You, too, can make it to the executive suite and pull down the big bucks if you just work hard enough and smart enough, starting when you're young. But that's akin to saying that if you just work hard enough and smart enough, you can play for an NBA team or win the British Open golf tournament. That's certainly true for a few people; for the vast majority, though, that message seems delusional and perhaps even fraudulent.
That in turn has led me to think that high executive comp, and the sense of vague disgruntlement among others to which it contributes, might be akin to the unremarkable public water pump that was discovered to have been the source of London's deadly 1854 Broad Street cholera outbreak, in which more than 600 people died in just a couple of weeks: [2] To outward appearances the water pump was innocuous and beneficial, but in reality it was silently poisoning the community and attacking the social fabric.
In the pre-ACA world, those who were healthy might save in rates by opting into lifetime caps, but those who didn't want the lifetime caps -- i.e. those more likely to get sick -- ended up paying more than they do now. The whole idea behind the ACA is to equalize the playing field between healthy ratepayers and sick ratepayers.
> I don't understand why you'd phrase it this way. Under the ACA, 80% of premiums have to go to medical care. A dollar saved providing care disproportionately benefits the premium payers, not the company.
The retained premiums rule and the lifetime limit ban were both adopted as part of the ACA; lifetime limits only existed before the ACA, and indeed benefited the insurance companies.
> Lifetime caps insure that you, the ratepayer, aren't on the hook for unlimited liability.
No, ratepayers are not on the hook for unlimited liability without lifetime caps. They are on the hook for insurers expected costs plus capped profit margin, given the insurer being subject to uncapped liability for covered, medically necessary services, but the ratepayer’s exposure is well-defined upfront.
If an insurance company underestimates tail risk then it may not be solvent when it's time for you to make a claim. Not sure if this is what was meant, but a policy holder always assumes some risk even with caps.
Unless the insurance industry is insolvent you don't really have to worry about that. Any company you're buying insurance from has reinsurance against abnormally high payouts.
This makes the risk effectively zero since if the 'turtles all the way down' system can't pay out then we're probably in a state of national emergency.
I think that operating margin might not be a good metric for measuring this. Although, I do think that there is too much focus on the 80% rule in general.
I mean, if all of the insurance companies are really close to that already (or even marginally above it), then it shouldn't matter either way, right?
This comment breaks the site guidelines, which ask you to assume good faith, among other things. Please don't cross into personal attack, regardless of how wrong someone else is.
Every European health care system, I believe, has some way of limiting the amount of care provided to people. It is just not so out in the open as a dollar cap on what people can get in a lifetime. Not every possible, super-expensive procedure is approved to be available to people through the public healthcare system. (Would love to hear of a country that has "universal health care" that does not limit what procedures people can have done to see how it is possible).
Everyone can't get the best possible care unless those experimental and expensive procedures are just banned and we give up on expensive procedures becoming cheaper in the future. Cancer is the biggest reason for this. If you have a cancer and can afford to employ a small research team for a few million a year, your chances them finding a custom way to beat it is much better than just trying to select from the existing treatments already out there. Health care already is 17% of the US GDP and the US government spends more % of GDP on healthcare in America than almost all European countries.
Not sure the best way to a better health care system in the USA, but just uncapping how much can be spent under insurance plans, while fixing one problem, won't work in the long run (as we are already seeing).
> Would love to hear of a country that has "universal health care" that does not limit what procedures people can have done to see how it is possible.
It will attract quacks like shit attracts flies, so yes, of course there are limits: New treatments need to be more effective or cheaper for some well-defined ailment to end up on the approved list.
If they're very expensive, they might not be first in line (but still available for patients where the case can be made that they need it). That can be frustrating, but shouldn't be life threatening.
Experimental treatments are research. Their test subjects are picked by a schedule that is unrelated to medical care needs but optimizes for good data acquisition. Pay for them from research budgets, not health care.
> If you have a cancer and can afford to employ a small research team for a few million a year, your chances them finding a custom way to beat it is much better than just trying to select from the existing treatments already out there.
Is there a public example of a rich person that 'beat' cancer this way?
Not really (that I know of). Andy Grove did spend a few months researching cancer before forcing his doctors to give him a new treatment that was showing better lab results than the traditional one, and the cure he got was probably better than the transnational one (less side effects). However from what I can tell the only thing he spent was his own time which means nothing a poor person couldn't do.
The option is open to anyone who is rich, and if you have an slow incurable cancer it is reasonable to try: you don't have anything to lose and it might work. Of course if your cancer is already curable focus on the existing cure. If the cancer is fast you don't have enough time to for research to produce results. At best it is a long shot, but it is what you have.
If you are young and healthy you actually have a better chance of your small donation making a difference. Just figure out what cancer you are at risk for and start regular donations to that research now. While your donation alone won't do much, the regular source of income helps those already doing the research keep going for the years required to get results. Your smaller donation along with others goes farther because time is a factor. The only problem is which: the cancer mom's mom had, the cancer dad's mom had, the cancer mom's brother had, the non-hereditary cancer both dad's brother and sister had, the cancer someone else in the family will get in two years?
This is definitely one of the drivers of lower healthcare costs outside the US.
A good example is the cbc.ca article where two friends were diagnosed with the same cancer. The one in the US got treated with the latest cancer drug and is remission, where the woman living in Canada has to sell her house to pay for it.[1]
"It's crazy that I live in Canada, but now I'm looking at having to sell my house for coverage of my medication."
This seems to be pushing a myth: expensive treatments must be better treatments, right?
We have very good evidence that these new, expensive, treatments do not extend life and that they make quality of life worse.
England set up something called the Cancer Drugs Fund. This provided access to new medication that hadn't yet been assessed for value; that were in the process of being assessed; or that had been assessed and were found to be too expensive for no benefit over existing treatment: https://en.wikipedia.org/wiki/Cancer_Drugs_Fund
> This seems to be pushing a myth: expensive treatments must be better treatments, right? We have very good evidence that these new, expensive, treatments do not extend life and that they make quality of life worse.
It's not pushing any myth at all. As explained elsewhere government-run systems like the NHS do attach actual dollar amounts to treatments that are effective and do extend life, but for which they're not willing to pay.
The NHS's version is actually quite ruthless when you peel back the details, where they determine how "good" a person's life is, and essentially how much they are willing to spend to extend that person's life by N years. This is, in effect, a benefits cap, just framed slightly differently.
This is not, as you are implying, saying "this treatment is ineffective or harmful, so we won't pay for it". It is literally saying "we understand that this treatment would extend this person's life by 5 years, but it costs £50,000, and based on their condition, we're only willing to spend £25,000 to extend their life by 5 years.
> And yet it has worse outcomes across a range of measures, including "life expectancy".
Life expectancy has so many confounding variables which have a much stronger effect that it's ridiculous to try and use that as a measure of a healthcare system directly. It's like trying to measure the fuel efficiency of different models of cars by looking at the total number of miles driven by all drivers of each car model in a given year. Yeah, there's... a connection between the two, but that's certainly not what you're analyzing when you try to compare them naively.
> where they determine how "good" a person's life is
No they don't. This is not true.
> This is not, as you are implying, saying "this treatment is ineffective or harmful, so we won't pay for it". It is literally saying "we understand that this treatment would extend this person's life by 5 years, but it costs £50,000, and based on their condition, we're only willing to spend £25,000 to extend their life by 5 years.
This is just not true. Find just one single medication that i) extends life by 5 years ii) costs just £10,000 per year and iii) has been banned.
> Find just one single medication that i) extends life by 5 years ii) costs just £10,000 per year and iii) has been banned.
It seems like you don't understand how coverage works for cancer treatment. The question isn't whether the medication is banned outright - it's whether it will be approved to be used for a specific patient in their treatment plan (paid for by the NHS).
> It seems like you don't understand how coverage works for cancer treatment. The question isn't whether the medication is banned outright - it's whether it will be approved to be used for a specific patient in their treatment plan (paid for by the NHS).
Please tell me how you think cancer drug funding works in England, because I'm pretty sure you're wrong.
But let's assume for the moment that you're right: please link to an article about a patient who would have been kept alive for 5 years if they'd been given treatment but they were denied the treatment because it cost more than £50,000.
If anything the UK was spending too much on cancer drugs that provided no benefit - no extension of life, combined with unpleasant side effects that lowered quality of life.
> Please tell me how you think cancer drug funding works in England, because I'm pretty sure you're wrong.
Just to be clear: you're telling me that you think QALY calculations are not factored into the decisions of which treatments will be covered for an individual cancer patient under the NHS?
Life expectancy in the US is low largely due to anomalously high fatal injury rates (e.g. automobile accidents) and homicide particularly among younger cohorts. These factors are unrelated to medical outcomes. And in fact US medical outcomes are significantly better than average in this regard.
Once you've made it past your 20s, life expectancy in the US is quite good.
When you look at different causes of death (diseases of the circulatory system, neoplasm, disease of respiratory system, external causes, mental and behavioural, diseases of the nervous system, and endocrine nutritional and metabolic disease) the US does worse than average on every single one of them apart from cancer.
> The U.S. has the highest rate of deaths amenable to health care among comparable countries
> Researchers have looked at mortality that results from medical conditions for which there are recognized health care interventions that would be expected to prevent death. While the health care system might not be expected to prevent death in all of these instances, differences in mortality for these conditions provides information about how effectively health care is being delivered. In 2006, the last year for which reasonably complete information is available, the U.S. had the highest mortality rate for deaths amenable to health care among the comparable countries.
The ACA significantly shored up benefits for members of group plans. It also, I hear and read, provided significant cost controls that helped put the brakes on group policy premium increases. Just one aspect of that: Hospitals' uninsured treatments dropped from the mid-teens or worse to around or under 5%. Costs that no longer had to be "spread around" to insured coverage.
But a lot of group policy members have no... pardon me, "fucking" clue about this.
Study after study has demonstrated this lack of knowledge.
And politicians have been complicit in furthering it, along with outright lies casting the ACA in worse light. Not to mention deliberately sabotaging it through their actions, such as not providing promised transition funding written into the law. (For those who don't know, this is a common political ploy: You can write any law you want; if you don't, through the separate appropriations bills, fund it, that law effectively accomplishes little or nothing.)
Still, even a superficial examination of the U.S. medical field inclusive of insurers, shows it to be awash in money.
Every fucking middleman (that includes many providers, from products to services -- and the suits who now own them) pushing to grab as much of it as possible, before the rest trickles down to the patient (actual care).
Pardon my vitriol, but I've encountered far too much of this, first hand.
I am a moderate conservative. I believe in self-reliance, fiscal responsibility, limited government. But receiving a death sentence like this one, physically and financially, is something I believe society could easily work together to create a parachute for.
It seems reasonable to me that not all healthcare should be covered by the government. Individuals need skin in the game for their own care. But catastrophic, life-ending diseases like cancer are a public crisis that every single one of us has been affected by in some way.
If there's a reason for government intervention of some kind, it's that.
> . Individuals need skin in the game for their own care.
1996 a friend got lung cancer at 32 she lost everything and died. In 2002 both a friend and I got sick. He's dead, I lost everything but I'm still here.
Seems to me we all had skin in the game. But hell if I know what a 30 year old woman and two men in their early 40's could have done different.
A lot of people are like you. Myself included. Which is why this topic is a front-and-center part of the democratic strategy for 2020. And if there isn’t a working alternative proposed by Republicans I don’t see much hope for them.
I think Republicans were caught off guard by the initial negative reaction (even amongst their own constituents) to potentially repealing the ACA without an alternative. Having painted themselves into an ideologically extreme corner, they never anticipated that the public wouldn't consider "repeal and replace with literally anything" to be sufficient.
Healthcare gets an emotional reaction from people. And honestly it should. What’s A budget balance when someone you love has cancer and can’t afford treatment? Nobody cares at that point.
Most of the public conservatives (talk show, tv) that I follow seem really out of touch with this. They should talk to their base. I think they would realize how dire the situation is and how easily it can sway 2020.
Perhaps the real problem is that chemo, radiation, and surgery don't really cure cancer, in most cases. There is a lot of bad science in cancer research. The "science" that bothers me the most is the use of 5-year survival rates.
Suppose that a cancer that starts at age 60 becomes symptomatic at age 65, and kills the patient at age 70.
Scenario 1: you are 60 years old, get screened, and opt for treatment (who wouldn't?). However, the treatment does temporarily put the cancer into remission, and you are "cured" at age 65. But then the cancer comes back, now resistant to the treatment, and you die at age 70.
Scenario 2: you don't get screened, and die at age 70.
Both outcomes are the same, but in the first scenario your oncologist declares you "cured" at age 65.
This kind of statistical chicanery leads people to opt for treatment, which is usually very bad for you.
If you or your child has cancer, could you bring yourself to not spend every penny you have? Most people would opt for treatment. But it's often a futile waste of money and life, as the article points out.
You're being very misleading when you say "in most cases". There are a lot of very common cancers that respond very well to treatment.
"If you or your child has cancer, could you bring yourself to not spend every penny you have?"
This is what health insurance is for. You buy insurance so that you don't have to worry about monetary decisions and can make decisions based on quality of life.
> This is what health insurance is for. You buy insurance so that you don't have to worry about monetary decisions and can make decisions based on quality of life.
When it comes to big medical problems, health insurance is rarely 100% effective against monetary problems.
Just wait a minute. Even with your deductible and max out of pocket you will find that your provider was out of network or that drug isn't covered or that procedure wasn't. Or is considered experimental (when it isn't).. Or something was denied incorrectly and what not. Even in the best scenario say deductible only costs... say you get sick in December with a 15k deductible you're now at out of pocket 30k by February.
You should do more research. Most skin cancers are trivial to treat. Testicular cancer, one of the most common cancers in boys and young men is, for the most part, extremely treatable as long as it's caught relatively early.
As a cancer survivor, this is completely unfounded in fact. Most cancers are treatable, as long as they haven't metastasized. Even cancers that have metastasized can be treated successfully, though the standard of care is much more difficult.
> This kind of statistical chicanery leads people to opt for treatment, which is usually very bad for you.
In the 70ties survival rates for cancer was 25% today it's 50%. You think that's because we discover it sooner and tweak statistics.
Sure statistics can be made misleading, but overall stats comparing survivor rates across decades can be expected to correct for stages and time of discovery.
Parent post makes a reasonable point about the problems of 5 year survival rates in a culture of massive screening of otherwise healthy people.
If you scan every man over the age of 55 you'll pick up a lot of prostate cancer. If you then do nothing else at all your country's 5 year survival rate improves because you have a bunch of people who'll die with, from from, cancer.
Survival rates are conditioned on stage and grading. Scenario 1 you have stage 1. Scenario 2, you have stage 4. The 5 year rate differs for each stage.
One quibble: child cancer and adult cancer are treated differently. Children can actually take a whole lot more punishment (they tolerate toxicity better, have more ability to recover afterwards), so for some cancers the success rate is substantially higher than for adults.
Yes. I think after 10 years you are pronounced "cured", which means no clinical presentation after that time usually means this type of cancer won't come back.
The 5-year interval is the minimum used in studies on cancer survival benefit.
Right now my grandmother has stage 4 cancer, and has opted to not treat. The chances were very low for survival and the process painful. I'm pretty sure I would opt similarly if over 60. It sucks, and it's hard to see her that way. I'm heading over to see her after work in a few minutes (she's gotten worse the past couple days).
I don't think it's responsible to always opt for treatment. It sucks and it's a hard decision to make and everyone needs to decide for themselves. Your scenario 1, for example also likely includes $30-200k in medical bills that your family has to pay when you die. Do you have your estate in a trust? There's a lot of things that nobody considers.
Your family doesn't have to pay ANY of your medical bills when you die. Hospitals will try to guilt them into paying, but there's no legal obligation (this doesn't apply to spouses, but there are ways to protect them).
What? Super unlikely a cancer diagnosed at 60 which killed you at 70, while showing complete remission at 65, would have let you live 10 years without treatment.
Most people survive early stage cancer. Very few survive late stage cancer. Very often cancer is diagnosed late stage, which is the main reason for cancer lethality.
I am sympathetic. From HN stories, the US health care situations seems abysmal.
BUT, i want to make 3 counter points, if only for the sake of discussion.
a. Cancer for many is a terminal disease. There are always some very very expensive and experimental or marginal treatments. If u have money, and are going to die, and decide to spend all you can to squeeze an extra year of life , i am very sympathetic but even the most generous European have spending limits.
b. This is about the US. The US has made a conscious decision to low-tax and low-safety-net. This is very harsh for the ill or poor. But this choice is reaffirmed every 4 years by sort-of-functional elections at multiple levels of government. Bernie never even made it past the primaries.
c. No one mentions the non terminally ill 95% who presumably enjoy high salaries for years and years (only in the US could a new $60K car be described as "a low cost model")
> only in the US could a new $60K car be described as "a low cost model")
Not even in the US is that description remotely reasonable; $60K is above the average new car price...not just overall, but even in the “Luxury Car” segment.
Buying a $60k car seems like a completely insane concept to me, even with a Silicon Valley tech industry salary. Even $16k (used) was higher than I wanted to pay for my current car.
You have a good mindset. A lot of people view a car as a status symbol and derive its utility from a social point of view, which I think is financially unhealthy. To me all I care about is 1: How safe is it?. 2: How much will it cost me over its lifetime? And 3: Does it get me and my stuff where I want to? Everything else comes far behind these three things.
People really shouldn't be borrowing money to buy a car. It's pretty crazy how many people do this.
Depends, borrowing money to buy a car and needing to borrow money to buy a car are 2 distinct things. I recently got financing for a new car because they gave me thousands of dollars discount for doing so. Over the course of the loan, if I pay it according to the full 5 year schedule they'll obviously get more in interest back but I plan to pay it off very quickly (and yes, I did make sure the financing contract allows to do that without having to pay off the entire schedule interest, only the interest accumulated until the time of the payoff).
As for the general idea what people should do with their money, I try to avoid those discussions because it's just a matter of priorities. To you it's more important to use your money to do other things, to others it's important that they drive a nice car. Life is too short and we should spend it pursuing that which makes us happy.
Respectfully disagree. Recently leased a $60k car and I enjoy every single minute I'm driving it. I'm not paying for a transportation vehicle, I'm paying for joy and pleasure. What else should I spend money on? Burgers and coke?
I won’t tell you what to do with your money, but there are a lot of cheap fun cars to drive out there. If you want fun to drive combined with new features like automatic lane keeping, dynamic cruise control, etc. you may need to shell out a little more for it.
I encourage high-earning tech workers to save more money in general - these are boom times. $60k pays rent on a room in the bay for a long time if you’re unemployed. I’m gonna buy the house before I lease the Tesla. But don’t know about your personal financial situation.
I was totally going to buy and enjoy a sports car when moving back to the states after 11 years abroad with no car at all. Then we got pregnant and...the dream has to wait ~5-10 years as I'm now into fancy strollers. :).
I can empathize. I've never paid even as much as $3k for a car. The idea seems absolutely ridiculous to me, yet I still hear about people not much better off than myself who spend as much on a new car as I would on a modest house.
If your gross income is $80,000, overall federal income tax is 17%. There's also the 12.4% social security tax and the 2.4% Medicare tax, so the overall rate is 32%. State income tax varies (in CA it's 6% on the $80000, in TX it's 0%).
The equivalent UK income is 61200 GBP. Income tax is is 21%, and National Insurance is 8% for 29%. This doesn't include the 20% VAT on most goods and services, but that also doesn't apply to all your income (doesn't apply to savings, housing, utilities).
If you calculated the equivalent income by converting dollars to pounds, that isn't a good measure of equivalence. £61k is a huge salary, especially outside London. It's even high for a programmer 5 years in. Whereas there are plenty of roles that pay $80k, and it would be insulting for most programmers out of uni.
You're right, using the PPP to GDP ratio says the pound has 1.11x the purchasing power of an equivalent amount of dollars. (equivalent meaning by foreign exchange rates)
Plus many European countries have _lots_ of taxes that aren't income tax, that don't apply to the US to the same degree. Not sure how this works out for the UK or Germany, but a high-income earner in Norway who uses a lot of their disposable income might pay 75% of their pre-tax salary in taxes and fees. This is in spite of an income tax that is 43% at the top marginal bracket, of which ~8 percentage points is in effect forced pension savings.
> only in the US could a new $60K car be described as "a low cost model"
You're almost right, just one country too many :)
That's not considered a low-cost car in the United States. If you think it is, then you've been spending too much time around the type of people who hang out on Hacker News.
Regarding A: I think it is important to note, that cancer is usually survivable, if caught early. This might make the "all in" phenomenon not inherent to the disease, because affordable, frequent checkups and education, might prevent many late stage cancer cases. Especially for colon and skin cancers.
Regarding C: Sure, everything is fine in healthy years, but 20% of the population is going to die from cancer alone. So it's not like only a tiny fraction is going to experience this dread.
In the US here. 60K is by no means consider a low cost car anywhere, however yes, that could be considered a low cost model if you are talking about a high end sports luxury brand, but even in that case doesn't make much sense since BMW, Mercedes and all have low cost entry models that are far below 60k, and for the the even more premium brands there lowest price cars are probably over 100K. So not sure which brand you are referring to where 60k is the entry model?
But yes if someone has money and little to no family they will spend it all trying to save themselves. Where is if they have a family they are more likely to try to live while also knowing its unlikely and thinking to the future for their families.
Also the US Congress has made the decision about low-tax low safety net. The majority of American's accordingly to the popular vote in the last election voted for democrats that would have been higher tax and higher safety net. So majority of Americans do not support the current Congress in power's approach. Hoping our health care system is fixed some day but with the power those lobbyist hold that is highly unlikely even with different leadership in charge.
True, for about 50% of people it is terminal.
I doubt the overlap is perfect.
> c. No one mentions the non terminally ill 95% who presumably enjoy...
True, however, about 50% of people will get cancer at some point in their life.
So I guess for a lot of people it's more like you live well, until you get sick. And almost everybody gets serious illness at some point (such is life -- it ends).
Not only is it not far off, the practical personal tax rate is actually higher in the US than in several European countries. It's not as simple as "the US has lower taxes, and therefore fewer public benefits".
Here's the thing. Cancer comes in basically two types. That which is treatable, and that which isn't. This can be either because of the type of cancer, or based on how early/late it was detected.
A lot of (possibly most of?) the money spent treating cancer is spent in cases that have very little chance for long term success. I don't think it really is, but it almost seems like a deliberate attempt to extract all the wealth from the patient before he dies.
It's not deliberate, but that's just how the incentives align. You have expensive treatments with outcomes not much better than control/placebo[1], but doctors and hospital administrators prefer to have nicer houses and drive better cars, so this is what you get. It's not their problem if patients pay tens or hundreds of thousands of dollars more, based on the hope of being in the small percentage of those who get good outcomes.
Medical services are an inelastic good. If someone has a problem that's a serious threat to life or happiness, they will spend every penny they have and some they don't on the slightest chance to avoid it. Competition, for various reasons[2], doesn't work well.
[1] In some cases where the intervention has slight mean/median benefit. In other cases, the outcomes are no better than control/placebo, even on average, but studies funded by drug companies or medical suppliers suggest that the intervention outcomes are better than controls, due to scientific mistakes or even intentional fraud (starting with bad experimental design, then cherry-picking data and cherry-picking studies).
[2] Comparison shopping works well for choosing suppliers of standardized drugs and services, in non-emergencies, but even that's usually torpedoed by what your insurance will cover; If you have the luxury, you can compare various brands of drugs that have generic versions. You can comparison shop for prices for blood draws and scans (CT/MRI). Beyond simple things like that, the treatments are not identical so comparing costs is difficult. Also, patents. Nobody will raise the price of a drug 100% in a day, but companies build in fatter and fatter margins because they have a patent monopoly, and everyone else is doing it to. There is no price control through competition except where there are genuine equivalent goods. Since healthcare is largely price-inelastic, without strong competition on the supply side, you get runaway costs. This shouldn't be a surprise.
It'd be helpful to track down where the wealth goes. It seems to be broken down between the care provider, hospital, pharmaceutical companies and possibly the insurance company. Has anyone fully tracked down averages on where the money tends to go (possibly different for different types of cancer?)
Depends on the treatment. The cost to a hospital of a typical chemo visit is roughly 50% drugs and 50% labor. An endoscopic surgical procedure for lung cancer is roughly 70% labor and 30% supplies. The average total costs for both are in the tens of thousands of dollars. That doesn't include fixed costs, just variable costs.
And spend the rest of her life paying back medical debts that she shouldn't have to? To me, this sounds like indentured servitude and not acceptable in a first world country.
Legally divorce then cut a new will to leave 100% to the wife before you start your treatment. That way she's only out half at most if the medical debts take everything.
You'd have to be careful to not treat any money or assets as communal but so long as you go through the motions there's not much anyone can do.
That sounds like the sort of hacky solution I would be ashamed to ship, but would do if the project is systemically badly managed to the point where you can't expect the sources of problems to be fixed.
I have seen that with an acquaintance. She had insurance but there was a never ending string of things that cost $20k here, $10k there until she was wiped out and had to file for bankruptcy.
In the US even if you have insurance it's still a gamble whether you'll get wiped out or not.
Of the 9.5 million cancer diagnoses studied between 2000–2012, researchers discovered that 42.4 percent of patients (median age 68.6±9.4 years) spent all of their money, averaging $92,098. This follows disturbing news from earlier this year that 40 percent of Americans can't afford to pay $400 in case of an emergency. The math is not adding up.
No, the math doesn't make sense. Either the author of the linked article misinterpreted the journal article, or the authors of the journal article didn't reports their numbers correctly.
The only other conclusion might be that cancer strikes the "wealthy" (those with 100K in savings) more than the poor.
The poor just die from cancer. The lower classes "borrow" money from friends and family, because cancer makes a better charity case than "my alternator broke". The middle class, and lower upper class has savings and home equity, and spends all of that to fight cancer. The upper class can spend whatever it takes.
Though now that I think about it, maybe the alternator fix is the more effective altruism, because it's something that can keep someone from falling a rung on the economic ladder, and being unable to afford health care. There's never enough, is there.
1. I think the title may be a little misleading. Only 3% declare bankruptcy, though higher numbers deplete all their savings. It's hard to find a good estimate of per capita "savings". A search indicates that the median savings account balance in the US is about $5,000. The median 401(K) appears to be about $36,000. Based on this, I'll assume that means the typical out-of-pocket costs of cancer treatment are somewhere around $30,000. That seems in line with what the out-of-pocket costs for 5 years of treatment might be under my current coverage.
2. The problem with any discussion of healthcare issues is that we are naturally swayed by our empathy for those who are suffering. Almost all of us would choose to pay whatever was needed to save a loved one, and would grant that ability to others if we could. It seems simple enough to say "we should spend less money on the military/international aid/tax breaks for corporations/the NEA/etc." if it means that we can provide affordable treatment to those who are suffering. Unfortunately, until the singularity arrives there is probably always going to be a cost that is too high, and hard decisions must be made. As a Canadian, I know that one of the downsides of universal healthcare is that some treatments must be rationed and bureaucrats will make decisions affecting the life of my loved ones. Now that I live in the US I can avail myself of diagnostics and treatments that may simply not be available in Canada. The cost may beggar me and the likelihood of a positive outcome may be remote, but it is my choice, and a choice that may not be available under other systems.
3. No, I have not read all of the comments. As with many HN comment pages, the marginal value of descendant comments seems to drop off quickly.
Sometimes I think I'm really lucky. I was dx'd with stage 2b Hodgkin's lymphoma 20 years ago. Half a year of twice-monthly chemotherapy and then an agonizing month of daily radiation doses was able to eradicate the disease. Because of the health insurance I had with the startup I was then working for, my total out-of-pocket cost to was $0. We never paid a single co-pay or saw a single bill for any of the treatment (there were co-pays for the 10 years of follow-up visits).
To this day I don't know what the total cost of saving my life was. I guess it was 6 digits USD.
I contrast to the health insurance I have now. Were I to get sick like that again, I know my out of pocket expenses would be at least $8K per year, and I expect I'd hit that limit several times over the course of the follow-up period.
Although I personally find the last sentence unnecessary, I agree with the first part. I've noticed on multiple occasions the last few weeks on both HN and Reddit that headlines + reactions all somehow assume that when no geographic details are given, US is assumed.
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In most of the world, even in poorer EU states, these super advanced and expensive treatments are not available and people simply die without getting a chance. Occassionaly one hears in media about some crowdfunding campaing for „unique treatment in the US”.
Although a good point on itself to ponder about, I don't think in this particular discussion it is logical to compare the US to non-EU and poor EU countries.
I wonder how the predicted increase in life expectancy would effect this. I’d say the probability of getting cancer increases with age and then also more people will be ruined because of that, poverty in general will increase (if people survive). I believe that those factors will be one of the toughest questions for the future, and countries with no social way of handling this will be effected more than those with it.
She very likely signed agreements to be financially responsible for the treatment. This is one of the very first forms a hospital will ask you to sign.
I've only been living for a couple of years on the US now but one thing that is among the hardest to get used to is the costs of medical care.
Often times going to the doctor once shields 3, 4 different invoices. I once made the rookie mistake of going to an E.R. for something I could have waited for, I think I had one of those head splitting head aches. They charged me something like $800 or so for ~10 minutes with the doctor. Another time, I had to pay something crazy like $300 for an X-Ray. Gotta pay for the cost of research of development for that cutting edge technology, X-Rays, huh? :-p
I can only imagine what it would be like if I had a very severe condition like cancer.
This is specially shocking for me coming from a country where health care is of high quality and publicly accessible (Argentina). Private care is also available and reasonably priced, the reasons to go that route is shorter wait times for appointments, nicer facilities, etc.
What are your life savings for if they can't be used to save your life? Every other use is fortuitous but until you have more money than you could spend to save your life then that is the purpose of that money.
I had an uncle who was quite well off and ran an exotic car garage in the US. He had all the insurance, etc. His wife got cancer, insurance wouldn't cover some of the treatment. She died, he went bankrupt, then killed himself.
I'm glad I live in a country where I literally don't even think about treatment or care, it's just not something I worry about. I've had a few relatives in NZ who've had cancer, they've all had excellent care which prolonged their lives and when they passed they didn't leave their survivors with the financial strain in addition to the heartache of losing a loved one.
Normally, I'm all for invisible hand capitalism for most things, but clearly in the case of medical services it's completely broken.
What we need is price ceilings on medical procedures, something reasonable. Perhaps, cap procedures cost in some way, maybe 1k to 4k based on what it is (make it illegal to charge more and hold hospitals financially accountable). There has to be some kind of cost control, either from the government or the insurance companies. We can't expect patients to choose these cost controls. I realize this means that some procedures won't be done but it's better than bankrupting everyone left and right.
It's only broken because of regulation. If I could shop across state lines for insurance, prices would drop. I may not even opt to get insurance as I'm very healthy and I've never had medical costs approach even an order of magnitude of my insurance costs. Yet I'm forced to purchase this unneeded service by the government, pushing up demand and prices in an artificially controlled market.
I see this mentioned a lot as a cost cutting measure: buy insurance across state lines. I don't see how purchasing insurance in another state would help. Every medical facility where you live would then be out of network. How do people think this would work, exactly?
Sometimes I’m just amazed that people haven’t risen up in bloody revolt yet. Recently my mother had a flare-up up radiation-induced pneumonitis and the PPO insurance she pays $14,000 annually wouldn’t approve a single unit of Advair. It took a week of talking to doctors and insurance drones to figure out that they were pushing her to an alternative that cost them $100 less.
If I woke up tomorrow and people were burning Wall Street to the ground I’d be less than shocked.
Again and again history reveals a surprising fact: you can push people really far before they finally reach their breaking point. And when that breaking point is finally reached, the trigger will not be what you expected.
This is especially true when there are no obvious and politically viable good alternatives. In the US everyone outside the center-left or center-right seems to be an absolute lunatic of one sort or another, and even if that weren't the case the two party oligopoly system is deeply entrenched and guarantees that alternatives can't succeed. There's nobody who is both sane and electable that isn't part of the mainstream duopoly.
The more polarized people become between the two major parties the more deeply entrenched the duopoly becomes. People don't dare vote for anyone but D or R because otherwise the hated other side will win. It completely rules out any third party or independent.
Only two parties means there really isn't that much diversity of thought beyond a small number of hot-button issues, and it also reduces the work load for lobbyists and other influence peddlers. Fewer parties means fewer people that have to be begged, bribed, misinformed, or blackmailed to get whatever you want. It makes regulatory capture a lot easier to achieve.
I really don't think the American two party system is working. We need more of a parliamentary type system where you can have many parties and a greater variety of views can get a hearing.
In my experience living here, the majority of people are pretty sane, however the loud, insane voices are the ones that get media coverage. The media really does have a lot to answer for pursuing entertainment value over factually-based reporting.
Voluntarily voting and scheduling voting on a weekday during work hours is also problematic, because largely only people with a strong motivation to vote (read: single-issue voters on the fringes) usually end up voting, which polarizes political discourse.
I'm glad this is finally being discussed cogently. For the longest time one would be painted as un-patriotic or some other slur-of-the-moment for even suggesting there were vicious-cycles of pathologies in the current incarnation of this system. (And in how human psychology/game theory plays into it) But as you summarized, all incentives are aligned to maintain the status quo. How do we break out of this? Expansion of executive/corporate/partisan power is _nothing new_ in American history, and the trends and outcomes are very clear cut. (I do not know the answer, I've been contemplating this nonstop for the last decade at least, and the best answer I have is trying to engage more people to think about it)
What's remarkable to me is that very few people are even aware of the sheer mathematical/structural issues at hand: e.g. that we've expanded congressional representation from 1:(max)30000 citizens at the start, to 1:747184 as of 2017. We're engineers. We should understand scalability, and that _alone_ should be a giant red flag regarding its implications.
Congress has a heck of time getting anything done right now.
I can't imagine what would happen if it were comprised of 20 times the members with all kinds of minor political parties each with their own narrow agendas.
Personally I'm hoping at some point evidence based governance takes over. Which might mean it's not people doing it.
I think it could work. You would get alignment of subgroups and better representation. If say Berkeley wants to be a green party they would be. So the averaging out would take place in Congress vs at the ballot box. This would get more ideas into Congress and blur party lines.
Even if we could just find a way to keep people from thinking about political parties the same way they do about sports we could make a lot of progress.
Yeah, it's funny - from my superficial understanding political theory predicts that a first-past-the-post system turns into a two party system with the parties getting ever more similar ("median voter theorem"). But that's not what happened in the US in the last decade or so.
But agreed - proportional parliament allows for articulation of important non-majority views (such as the emergence of the Green party in Germany many years back).
Median voter theorem ignores a lot of critical things, the most critical being that political viewpoints may not be distributed normally (or even with a single central peak) and turnout is influenced by engagement.
If you assume engagement (and, thus, likeliness to vote) is driven in part by proximity of the nearest candidates positions to your own, and that political viewpoints are bimodally distributed, you'd actually expect FPTP to turn into a two-party system where parties, even if they start at some point close to each other, drift out toward the two peaks.
While still a gross simplification, this seems closer to reality in the US to the premises required for the Median Voter Theorem to work.
I expect social media trying to drive "engagement" has had a major effect. It appears that in both social media, and in politics, making sure people are as pissed off as possible about the other side drives engagement, and that also means turnout. This coming election in November is going to be very interesting.
It's interesting because in a prior post I had made illustrating why people have such strong animosity towards the rich it was claimed that I have that exact mentality.
In reality, the poor and middle class are the crabs trying to escape the wealthy wanting to boil us is the best way I can put it.
Half the population have below average IQ's, and even people with above average IQ's still struggle with abstractions. These topics are complex and it's easy to frame the negative state in a way for low IQ and poorly educated people to grasp, so they tend to side with what they "think" they understand.
His rebuttal to the "IQ has fat tails" argument isn't very convincing. He's arguing that IQ should be defined as your percentile rank converted into a numeric score based on a Gaussian of mean 100 and stddev 15, but then goes on to say that yes, the results of most IQ tests will deviate from that Gaussian in the extremes, but that's because the tests are inaccurate, and will have whatever distribution the test-makers give them (which is probably not Gaussian).
However, a definition that differs from basically every empirical measurement of that quantity isn't a very good definition! That's like defining pi as 22/7 or the fine structure constant as 1/137 because it makes the math easier. Sure, that's true, and it makes it easier to explain to laypeople...but you're going to have problems when you try to predict or draw conclusions about the results of any experiments. Same with IQ - you can define it as the percentile rank converted to a scale with 100 as the mean and 15 as the stddev, but if that yields the prediction that children with a 175 IQ (5 stddev) are going to be 1 in 2 million while the observed frequency on say a Stanford Binet L-M is 1 in 10,000, you're going to draw drastically erroneous conclusions. (In practice the WISC3 and Stanford-Binet 5th ed aren't very useful for highly-gifted children anyway, because they ceiling out around 140 IQ, and basically all IQs over that are estimated with either the Binet L-M or early administration of the SATs.)
where R is a raw score, that score is then translated into a percentile (by the cumulative distribution function F_R), and that is then translated into a gaussian ~N(100, 20^2) (by the inverse pdf F_N and constants 100, 20).
Case 2: IQ tests are of the form
c1 + c2 x R
where R is a raw score and c1, c2 are chosen such that E[R] = 100, Var[R] = 20^2.
If what is actually done is case 1, then what you say is correct, and saying "IQ is normally distributed" has no empirical content.
If what is actually done is case 2, then saying "IQ is normally distributed" translates to "R is normally distributed" and has some empirical content. In particular, R (thus IQ) might not be normally distributed.
(The article seems to argue, but doesn't make the case that case 1 is the case.)
EDIT to add: dunno what the Variance is actually, might be 15^2 rather than 20^2.
What would healthcare-centric revolt look like? You would need to apply pressure to specific congressional representatives, who support a specific ideology and don't believe in universal healthcare (A Crowdpac campaign has funded close to $4 million dollars to challenge Susan Collins when she's up for reelection due to her supreme court vote; that most likely won't scale). I could of course see rouge elements of such a movement using violence (not condoned!), but there has to be something legal that puts fear into Congress to act.
It'll start at the state level with single payer probably through medicaid expansion (medicaid for all). If the Feds aren't on board then you won't get the 50% match from the Feds but the premiums should help offset that. You might then get a few states who band together. What will happen next is that a lot of people will move to those states (as jobs permit) resulting in an economic bonanza for those states.
I would also like to see this started on a state level. I’m not sure why we have to do it “all or nothing”. Id it presents so many economic benefits then they can make it work on a state level.
> (A Crowdpac campaign has funded close to $4 million dollars to challenge Susan Collins when she's up for reelection due to her supreme court vote; that most likely won't scale)
This sort of thing should be illegal, particularly when it is out-of-state interests injecting money. If you live in another state, vote out your own reps you don't like.
The harassment the poor woman has been put through lately is obscene.
Money is considered speech. The legislative and judicial branches condone such actions, and the example you take issue with is the result of representatives having national impact (in this case, voting for the appointment of a supreme court judge).
And the judges she have been voting for (not just the supreme court, but across the federal judiciary where she's voted to confirm virtually every one of Trump's judge nominations) are generally in favor of fewer limits on campaign finance laws. I think if you vote by proxy for less campaign finance regulation, you should be fine with facing the results.
Requiring open finances for any organization that donates to political campaigns or advertisements for, or against a given party or candidate would go a long way.
Eliminating corporate personhood as a legal construct or adding a non-living entity construct as an amendment would help too.
Maybe the reason people haven't risen up in bloody revolt is a good number of them are also engaged in some sort of rent seeking or useless or parasitic endeavor which pays the bills and which, they tell themselves is needed and noble. After all, nobody wants _their_ gravy train disturbed.
The gears of the currently horrible insurance/healthcare fiasco are mostly normal, honest everyday people trying to get through life. With everyone trying to figure out how to get just a little bit bigger piece of pie. Gears in an out of control machine. And these gears are just doing their jobs and hoping for their bonus and hoping their homes keep appreciating and going home to their kids at night.
It's a horribly broken system in so many ways. But it does seem like the Health/Insurance complex (and maybe higher education) are among the most egregious offenders and are growing more outrageous by the year.
I think there is disagreement on what to burn down. Every level will insist vigorously that they aren't the problem, they are necessary and helping and that the problem is something else. It's not just the rich 1% either, the problem is also many of us at some level. If it weren't these things would be fixed.
The problem is that the young are less impacted so they don't care to vote. It's only when you have kids, have a health crisis etc.. that you start to take an interest. First understanding why something is the way it is and then advocating for change. Also, most people don't have major health issues (excluding an accident) until they are older (or have kids) .. And the largest consumer of health care are those aged 65+... So basically it's a hidden cost that people don't appreciate.
As an aside, the only good thing about student loans being so egregious is that it will bring out the youth vote.
Insurance is a legalized scam and it’s a shame it’s been made mandatory for everyone. Literally just a middleman now that does nothing except steal money from both sides.
Edit: wow yall are incredibly divided on this comment. I'd love to see the internal statistics on the upvote/downvotes this got, but it seems like it's something like -12 and +12
Health insurance drives the prices up for both patients and health care providers by thousands of percent. It's purely a malicious middleman that steals from both sides and does absolutely nothing beneficial at all. Except create jobs I guess, but is an inherently unethical job worth creating?
Other insurances like car insurance and renters insurance seem slightly more reasonable (although they're all inherently a form of gambling) and I haven't heard any horror stories about them, but I wonder, if I had saved the money I put into car insurance, would it be sufficient by now to pay damages for any car accident I may be at fault for?
As opposed to the government the majority of us people voted for previously which did so much better?
These problems apparently go well beyond political moniker and I find it confusing that anyone who has been paying attention feels voting for a different color talking politician is going to fix them.
> In the US, it would have been sufficient to vote for a different party. Enjoy the government, the majority of you people voted for.
Except in the lower house of the national legislature (where the dominant party is still significantly overrepresented compared to the popular vote for that body), the dominant party in the political branches of the US government was not supported by a majority of voters in election to each body, even if you only consider major party votes.
The other party wants to make revolt impossible by dismantling the 2nd Amendment. So it's a choice as to whether one wants slightly-better politics or much-better metapolitics.
- Three weeks in she was buried in paperwork. One chemo treatment would turn into 4-5 invoices from different subcontractors at a single hospital, some covered by her insurance, others not covered. Her insurer denied claims arbitrarily and made her go through a bunch of invasive and unnecessary procedures to prove her illness.
- Her insurer started calling her incessantly, insisting that she join some sort of program where they would “help” her make decisions about her care. It undermined the confidence she had in her doctors and the decisions she was trying to make, which is a terrible feeling for anyone to go through when they are sick with cancer and trying to survive.
- There were a series of insurance “land mines” on the horizon - forget to renew this thing on this random date 2 months from now? You’ve lost your insurance.
The whole healthcare and insurance system is a dark pattern, even for working adults who are fully covered.